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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />3 Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature <br />Health Permit <br />n»utw»c Tank <br />I <br />txx^uH- <br />t ■ a -*-« fu* <br />Str/irxj 'Wna 'itfhs <br />Stemo wChaftrig <br />Cfci: <br />GM <br />Hand •as), WW/s <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />5 Gal Harxl wash <br />Ww,:—B.U* <br />Garbage <br />Can <br />SAN JOAQUIN <br />COUNTY <br />Date <br />B Water supply dispenser with Warm water at a minimum of 100“F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of nnse/wastewater. <br />0 <br />' Ice Cooler <br />t/ld <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checkfist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. A <br />Title <br />rr r1 <br />FOru Icb X. FojJ Cunhtmy. naf bv El <br />stxeJ 6 nutea jiToTrfu: | <br />Names of responsible persons to be present in booth during all hours of operation: <br />bay . <br />** Important' <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45’F (if food is used the following day, maintain below 41 °F temperature): <br />Bice chests Refrigerator <br /> ice bath and tubs <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 4 64-0138 | www sjgov orq/ehd <br />TEMPe^NTAPP <br />I am providing the following itoms within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy waler, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon ot water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: 7